PGY-III
GOALS & OBJECTIVES
The PGY-III resident will build on the foundation of the PGY-I year and continued
learning of PGY-II year in making the transition to a psychiatrist who can function
independently with a modest level of supervision. The acquisition of the necessary
knowledge, skills and attitudes will be demonstrated by the substantial completion of the
goals and objectives of each clinical rotation, attendance at seminars, satisfactory
performance on the PRITE and mock board exams and satisfactory performance in the
longitudinal psychiatric clinic (UTP).
Knowledge:
Appreciation of scientific basis for psychiatric knowledge
Intermediate theory and practice of psychotherapies
Advanced knowledge of groups and family systems
Working knowledge of ethical and legal issues of psychiatric practice
The neuropsychiatric approach to patient assessment and treatment
Skills:
Supervised but independent functioning in outpatient setting
Presentation of clinical and scientific material in a group, educational
setting
Leadership skills in educational and administrative venues
Critically evaluate and summarize the scientific psychiatric literature
and present a summary of findings
Attitudes:
Conscientious work in a setting of increasing independence
Informed skepticism and curiosity about psychiatric knowledge
Willingness to function as a resource to colleagues and co-workers
Conduct an ongoing assessment of personal strengths and deficits
and develop strategies to address them
Competency-Based Goals.
The Accreditation Council for Graduate Medical Education (ACGME) has identified General
Competencies that should act as organizing principles for all residency training programs’
curricula, and reflect an expectation that all graduating residents of a program should obtain a
competency in these areas reflective of a level that would be appropriate for an independent
practitioner. The six general competencies identified by the ACGME are patient care, medical
knowledge, interpersonal and communication skills, practice-based learning and
improvement, professionalism, and systems-based practice.
All residents in our program are evaluated using these competencies, and expectations are defined
based on an understanding of progressive mastery of these competencies throughout the
resident’s training. The following table describes specific areas that should be evaluated at the
end of each rotation, with examples of what the expectations should be at this level of training.
Competencies by level of proficiency
Remedial
Developing
competency
Competent
Proficient
Expert
Interpersonal and Communication Skills
Working
Relationships
Ability to
Establish
Rapport
Inappropriately
antagonistic,
disruptive, arrogant.
Dismissive toward
staff members
Avoids contact,
insensitive, inattentive
to patient’s feelings
Inflexible,
inconsiderate,
frequently loses
composure
Cooperative. Adjusts
to circumstances.
Valuable team member
Occasionally
insensitive or
thoughtless. May
be superficial or
callous
Disorganized,
unfocused, some
omissions, gives
irrelevant or
inaccurate
information
Empathic and attuned.
Listens and conveys
information easily and
effectively
Complete, includes all
basic information, with
positives and relevant
negatives. Follows
standard format
Flexible, supportive,
fosters good rapport
within the team.
Interacts easily with
other disciplines
Excellent
communicator.
Perceived by the
patient as open,
helpful and capable
Well organized,
thorough, precise.
Effectively
integrates data.
Appreciates
subtleties. Concise,
comprehensive
Poised, establishes
mutual respect with
other disciplines. Seen
as helpful
Mastery of fundamental
psychopharmacology.
Excellent grasp of
advanced techniques
and in-depth
knowledge of the most
recent literature
Excellent theoretical
psychiatrist who is
Verbal
Presentation
Inaccurate, major
omissions, rambling,
inappropriate
comments
Pharmacotherapy
Major deficiencies in
the fundamentals. No
appreciation of
advanced techniques.
Requires constant and
extensive supervision
Has difficulty
applying basic
knowledge.
Rarely uses
secondary or
tertiary strategies
Good fundamental
psychopharmacologist
who is generally able
to apply advanced
techniques for difficult
and refractory cases
Very solid basics.
Often suggests
alternative strategies
and is aware of
recent advances in
the field
Psychotherapy
Does not grasp the
styles and applications
Some difficulty
with necessary
Good basic knowledge
of various
Expanded
understanding of
Attains the patient’s
full confidence. Able to
work adeptly with even
difficult patients
Polished presentations,
tailored to situation.
Outstanding, discussion
reflects thorough
understanding of
disorder and patient
situation.
Medical Knowledge
of different types of
psychotherapy. Rarely
suggests this
intervention
concepts such as
transference,
resistance, and
defense. Limited
appreciation of
combined
therapy
psychotherapies, their
unique vocabularies,
and applications.
Rarely hesitates to
employ this treatment
different strategies
including their
complexities and
subtleties.
Thoughtful about
the risks as well as
the potential
benefits of this
intervention
Effectively
integrates data,
incorporates
subtleties,
thoughtful
prioritization
fluent in the
terminology and
rationale for various
methods. Adept
biopsychosocial
modeling. Well-read in
classic and modern
literature
Descriptive
Psychiatry and
Differential
Diagnosis
Cannot interpret or
synthesize data, no
prioritization, likely to
miss major disorder
Some difficulty
with
interpretation of
data and
prioritization of
issues
Forms adequate
differential diagnosis
with appropriate
prioritization of issues
Diagnostic
Skills,
Assessment and
Evaluation
Unable to summarize
or organize psychiatric
history. Often
rambling or confused
Ability to
Develop Rapport
and Therapeutic
Alliance
Frequently unable to
engage patient in an
interview. Insensitive.
Disrespectful
Disorganized or
unfocused.
Limited
differential
diagnosis with
some omissions.
Lacks
biopsychosocial
format.
Adversarial with
patients. Doesn't
form a
therapeutic
alliance
Accurate,
comprehensive history
with description of
intrapsychic and
situational conflicts.
Careful and complete
differential diagnosis
Well organized.
Able to present
coherent and
relevant
biopsychosocial
formulation. A
skillful
diagnostician.
Outstanding discussion
that reflects thorough
understanding of illness
and patient situation.
Recognizes the value
and limitations of
various diagnostic tools
Makes patients
comfortable and
engages them in the
process of evaluation
and treatment
Can engage patients
well. Perceived as
capable. Very
respectful. Able to
elicit cooperation
even in awkward
situations
Comfortable with
the work of therapy.
Shows eagerness in
identifying,
understanding and
utilizing
transference and
countertransference
Has the patient's full
confidence. Works
exceptionally well even
with difficult patients.
Maximizes adherence
to treatment
Psychotherapy
Unable to establish
therapeutic alliance or
to formulate treatment
plan or goals. Cannot
utilize even the most
rudimentary strategies
of therapy
Able to appreciate
transference, to
identify major
dynamic themes and
multiple levels of
meaning. Applies
these with some skill
Pharmacotherapy
Unable to formulate
effective drug
treatment plans. May
be reckless or even
dangerous at times
Significant
deficiencies, but
aware of the
influence of past
experiences on
current
symptoms,
thoughts and
feelings
Usually able to
select a first line
treatment. Some
understanding of
side effect
profiles and
symptomfocused therapy
Treatment
Planning
Unreliable. Fails to
plan. Misses changes
in patient’s mental
status and/or fails to
follow up
Erratic in
planning and
follow up. Slow
to see changes in
patient status
Adequate management
plans and follow up
with recognition of
changes in condition
Patient
Communication
and Education
No effort to involve
the patient or to
provide
information/education.
Minimizes interaction
with the patient
Provides partial
information.
Little concern
for patient
autonomy or
informed
decision making
Discusses treatment
options thoroughly.
Actively informs the
patient of options,
risks, and more
PBL&I
Unable to incorporate
his/her own
Fully understands
complex issues and
problem interactions
Patient Care
Selects the best drug
treatment based on the
patient’s illness, side
effects and drug
interactions
Algorithmic
approach to
medication
management with
expanded
knowledge of
options. Able to
adapt fund of
knowledge to realworld patient
situations
Thoughtful, detailed
management plans
with regular,
thorough follow up.
Quickly recognizes
changes and adapts
as necessary
Helps the patient to
feel informed and
involved in
treatment decisions.
Spends extra time to
ensure adequate
understanding
Actively and
aggressively pursues
experience in various
psychotherapies. Able
to incorporate multiple
patients into routine.
Manages powerful
feelings with grace and
efficacy.
Outstanding ability to
formulate treatment
plans that address
idiosyncrasies,
refractory cases and
complications. Skilled
at maximizing
compliance
Efficient and insightful
management plans with
many options and
awareness of the risks
Gains the patient’s full
confidence by carefully
explaining complex
treatment strategies and
empathically
establishing a mutual
information exchange
Practice-Based Learning and Improvement
Struggles to
benefit from
Uses clinical examples
to learn treatment
Formulates
treatment in
Consistently and
accurately utilizes
experience. Limited or
no ability to use
rounds or patient care
as learning
experiences
ward teaching.
Erratic response
to feedback from
faculty and
ancillary
personnel
Management of
Clinical
Responsibility
Inappropriate,
antagonistic attitude.
Late to clinical
responsibilities with
no regard to
inconvenience of
others. Unprepared.
Often absent or
unreachable
Documentation
Inaccurate. Major
omissions.
Disorganized. No
appreciation of the
legal risks inherent in
charting
Teaching
Never teaches. Often
ignores the students or
expects them only to
provide service
Ethical DecisionMaking,
Honesty,
Cultural
Sensitivity
Does not accept moral
standards for decisionmaking. Prejudiced.
Dishonest. Attempts to
cover up errors
Personal
Qualities
Unreliable and
unfocused. No
initiative. Inflexible.
Takes credit without
shouldering blame.
Unprofessional in
dress and demeanor
Administrative
Skills
Unable to supervise or
inappropriately
supervises. Cannot
make decisions. Fails
to complete paperwork
and reports
Usually
present, but
frequently
disinterested.
Rarely
adequately
prepared.
Cannot keep up
with clinical
data. Difficult
to track down
Unfocused
notes with
many
omissions or
marked overinclusion.
Many late
and/or untimely
entries
Rarely teaches
and ineffective
when the
attempt is
made. No
active
organization of
educational
endeavors
Irregularly
applies moral
standards. Not
always
impartial. May
try to minimize
or camouflage
mistakes and
shortcomings
Inefficient.
Requires
frequent input
to motivate.
Poorly
responsive to
feedback.
Occasionally
inappropriately
dressed.
Overestimates
personal ability
Marginally
effective at
supervision.
Inconsistent
appreciation for
necessary
documentation
standards and
paperwork
planning, differential
diagnoses and followup. Steadily adds
individual patient data
to fund of knowledge
response to an
expanded awareness
of his/her
experience. Uses
rating scales and
objective measures
of efficacy
clinical experience to
improve patient care.
Readily gathers and
applies current
literature to own
patients
Adequately prepared
and organized for
clinical and educational
activities. Delegates
appropriately. Solid
attendance and
availability
Ably manages all
patient
responsibilities and
educational
experiences. Adept
at managing many
complicated
patients. Impeccable
attendance
Superbly organized
clinician with
exceptional attitude and
unusual ability to
coordinate care for
many complex patients
while participating
fully in educational
requirements of
residency training
Complete
documentation that
includes all basic
information and
satisfies legal
expectations
Well organized and
thorough. Precise
charting that reflects
appreciation for the
medical record as a
part of the patient’s
care
Concise without losing
completeness. Always
timely. Able to use the
medical record as an
important tool in both
patient care,
medicolegal affairs
Solid clinical teacher
who adds didactic
sessions to the students’
and lower-level
residents’ workday
Above average
bedside teacher who
conveys difficult
aspects of
psychiatric
knowledge to
learners of all levels
Exceptional and
enthusiastic teacher.
Systematically covers
many areas of
psychiatry for all the
members of the team.
Regularly arranges
educational experiences
Applies moral standards
to personal and clinical
decisions that are
relevant to the role of
resident. Admits errors.
Aware of cultural
differences
Ethical and reasoned
decision-making
process.
Acknowledges
equality of all
people
Exceptional decisionmaker who respects
human dignity without
bias. Utilizes cultural
differences to
maximize care delivery
Effective and reliable.
Flexible person who
implements feedback
effectively.
Appropriately seeks
help. Professional
appearance and
demeanor
Eager learner who is
efficient,
conscientious, and
helpful. Seeks
feedback. Accepts
the inevitability of
errors
Highly motivated and
exceptionally
productive. Always
helpful. Appropriately
seeks new
responsibility.
Accentuates the
abilities of the rest of
the team. Shares
success and credit
readily
Able to coordinate and
supervise a team. Good
planner. Ensures that
necessary
documentation is
complete and timely
Easily adapts to the
administrative and
supervisory role.
Independently
coordinates team
function
Exemplary organizer,
supervisor, leader.
Fosters excellence
within team.
Encourages compliance
with documentation
and required paperwork
Professionalism
System-Based Practices
S-B P
No appreciation of the
various structures used
to provide mental
health care. Frequently
mismanages patients
due to these
deficiencies
Significant
weaknesses in
ability to adapt
treatment to the
available
resources of the
patient
Recognizes the
realities of various
public and private
sector mental health
systems. Organizes
treatment with regard
to payor specifications.
Thoughtful, detailed
management of
patients with
appropriate regard
to the specific
system of care
available to the
patient
Well-versed in current
mental health financing
including carve-outs,
public funding and
private resources.
Develops elegant and
imaginative strategies
to maximize care